Objectives: Hysterectomy is an important procedure in the management of many gynaecological disorders. There are 3 popular methods of performing a hysterectomy; abdominal hysterectomy, laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy.

Vaginal and laparoscopic hysterectomy are associated with low surgical risks and involve shorter hospital stay in comparison with abdominal hysterectomy.  Reviews have also found that vaginal and laparoscopic hysterectomy are associated with fewer infections, episodes of raised temperature and women resumed normal activity more quickly compared to the vaginal route. We performed a retrospective review of total laparoscopic hysterectomy performed at our center over a 4 year period. Our objectives were to determine our progress in laparoscopic surgery and to identify areas for further improvement.

Methods: Patients’ informations are obtained from the operating theatre record book. Patients who have undergone a TLH during the identified period are identified and their clinical notes are traced.

Informations are then obtained from the clinical notes, looking for information on duration of surgery, intra operative complications, operative blood loss, duration of hospital stay, short term and long term complications. Our findings are then compared to published standards and rates of complications by other centers.

Results: We performed 58 TLH between 2013 to 2016; 6 in 2013, 15 in 2014, 24 in 2015 and 13 in 2016. The average surgical time operative blood loss and duration of post-operative hospital calculated and tabulated.

There was 1 bladder injury in 2013 requiring on table referral to Urology team for bladder repair and ureter stenting. There was 1 patient who had prolonged hospital stay in 2014 due to persistent post-operative pain and 1 case of rectovaginal fistula. There were 2 patients with subcutaneous emphysema in 2015 and no documented operative complications in 2016.

Conclusions: There remains a steep learning curve in training a surgeon to perform laparoscopy surgery. However, given the better outcome and lesser patient’s complications, laparoscopic surgery is still an important skill to learn and train. Our center has shown some improvement in reducing operating time, blood losses and rates of complications. Adequate training and a suitable selection of patients will make laparoscopic hysterectomy simpler to perform.